In revision total hip arthroplasty (THA), acetabular reconstruction while dealing with severe bone loss is a challenge. The porous tantalum revision acetabular shells have been in use for the past decade. Several reports have documented successful use at early to mid-term follow up. There is, however, very little literature around the long-term survival and quality of life outcome with the use of these shells. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects reconstructed with a hemispheric, tantalum acetabular shell and multiple supplementary screws. There were 31 females. Average age at revision was 64 years (range 23–85 years). The mean and median follow up was 11 years (range 10–12 years, SD 1). Morselised femoral allograft was used in 34 hips to fill contained cavitary defectes. Bulk femoral allografting was performed in 2 hips. At a minimum follow-up of 10 (range 10–12) years, the survivorship of the porous tantalum acetabular shell, with revision of the shell as end point was 96%. The minimum 10-year survivorship with hip revision for any reason as end point was 92%. We noted excellent pain relief (mean WOMAC pain 92.6) and good functional outcome (mean WOMAC function 90.3, mean UCLA 5); and generic quality of life measures (mean SF-12 physical component 48.3; mean SF-12 mental component 56.7). Patient satisfaction with pain relief, function and return to recreational activities were noted to be excellent. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent clinical and quality of life outcomes at minimum 10-year follow-up. As far as we are aware this is the first report of minimum 10-year follow up of use of this technique for revision hip arthroplasty.
Revision surgery for pelvic discontinuity in the presence of bone loss is challenging. The cup-cage reconstruction option has become popular for the management of pelvic discontinuity in the recent years. The aim of this study was to review the clinical, radiological and patient reported outcomes with the use of cup cage construct for pelvic discontinuity at our institution. Twenty-seven patients (27 cup-cage reconstructions) were identified at median 6-year (minimum 2 year, maximum 10 years) follow up. Eight were female patients. The median age was 77 years [mean 72, range 37–90, SD 13.6]. There were 5 deaths and 2 were lost to follow up. Two patients were converted to excision arthroplasty; one for infection and one for failure of the construct. A further 3 patients required revision for instability but the cup cage construct was not revised (2 revisions of cemented cups to a constrained cup and one revision of proximal modular component of the femoral prosthesis). Revision of the cup cage construct was not necessary in any of these cases. We noted excellent pain relief (mean WOMAC pain 85.6) and good functional outcome (mean WOMAC function 78.2, mean UCLA 5, mean OHS 78.6). Patient satisfaction with regards pain relief; function and return to activities were noted to be excellent. Radiological changes were noted in further 4 patients (cup migration in one case; fracture of ischial spike in one case and breakage of the cage screws in 2 patients). No migration of the construct was noted in any of the cases. In conclusion, the cup cage construct is an excellent method of dealing with complex pelvic discontinuity. Our study suggests a low failure rate; high patient satisfaction and pain relief and moderate functional outcome at median 6 year follow up.
Periprosthetic joint infection (PJI) complicates
between 0.5% and 1.2% primary total hip arthroplasties (THAs) and
may have devastating consequences. The traditional assessment of
patients suffering from PJI has involved the serological study of
inflammatory markers and microbiological analysis of samples obtained
from the joint space. Treatment has involved debridement and revision
arthroplasty performed in either one or two stages. We present an update on the burden of PJI, strategies for its
diagnosis and treatment, the challenge of resistant organisms and
the need for definitive evidence to guide the treatment of PJI after
THA. Cite this article:
Non-invasive extendible endoprostheses (NIEE) were primarily developed for salvage after musculo-skeletal tumour surgery in the immature skeleton. However, they may also have a unique application to manage complex limb reconstruction in revision surgery to address limb-length inequality in the mature skeleton. The aim of this study is to present the minimum 2 –year results of using non-invasive extendible endoprostheses for complex lower limb reconstruction. Between 2004 and 2013, 21 patients were treated with 23 NIEE. The indication for surgery was salvage of infected prosthesis following primary tumor resection in 6 cases, aseptic prosthesis failure after primary tumour resection in 5 cases, aseptic non-tumor prosthesis failure in 1 case, infected non-tumor prosthesis in 8 cases and symptomatic non-union of graft reconstruction in 3 cases. There were 14 male and 7 female patients with a mean age of 49.8 years (range 19–81).Introduction:
Methods:
There has been an in increase in the availability
of effective biological agents for the treatment of rheumatoid arthritis
as well as a shift towards early diagnosis and management of the
inflammatory process. This article explores the impact this may
have on the place of orthopaedic surgery in the management of patients
with rheumatoid arthritis. Cite this article:
Infected periprosthetic fractures around total hip arthroplasties are increasingly common and extremely challenging problem. The purpose of the study was to review the experience of two tertiary referral units managing infected periprosthetic femoral fractures using interlocking long-stem femoral prostheses either as temporary functional spacers or as definitive implants. A prospective review of 19 patients managed at two tertiary referral units between 2000 and 2011. Each patient was diagnosed and managed according to similar institutional protocols. Investigation through aspiration and biopsy of periprosthetic tissue supplemented haematological tests to confirm infection. The Cannulock uncoated stem was used in 14 cases, and the Kent hip prosthesis in 5 cases. Allograft struts were used in patients with deficient bone stock. The mean follow-up for the series was a 53 months (range, 24–99 months). 13 patients underwent definitive revision within 7.9 months (range, 6–10 months; SD, 2.2 months). In 6 cases we implanted an extensively porous-coated stem, in 4 cases a tapered distally fixed cementless stem was used, and in 3 cases a proximal femoral replacement was used. There were no reinfections after the second stage revisions in these patients. 2 patients were offered further staged surgery due to persistently raised inflammatory markers but being mobile and relatively painfree declined. They are being managed in the community on oral antibiotics. Satisfactory outcome was noted in all cases, and in 13 cases, revision to a definitive stem was undertaken after successful control of infection and fracture union. The average postoperative Harris Hip score was 83 (range 79–89). All patients returned to their low to moderate premorbid functional state after discharge.Methods
Results
There have been concerns regarding the quality of training received by Orthopaedic trainees. There has been a reduction in working hours according to the European working times directive. National targets to reduce surgical waiting lists has increased the workload of consultants, further reducing the trainees' surgical experience. Navigation assisted procedures are successfully used in orthopaedics and provides useful feedback to the surgeon regarding precision of implant placement. We investigated the use of navigation aids as an alternative source of training surgical trainees. We choose a navigation assisted knee replacement (TKR) model for this study. A first year Orthopaedic registrar level trainee was taught the TKR procedure by a scrubbed consultant in 5 cases. He was then trained in use of non-CT based navigation surgery. The Trainee then performed navigation assisted non-complex primary TKR surgery. A consultant Orthopaedic surgeon was available throughout for advice and support. Data collected included pre and post procedure valgus and varus alignment of the knee, total operative time and WOMAC scores pre and post operatively.Introduction
Methods
In recent years, there has been a significant advancement in our understanding of femoro-acetabular impingement and associated labral and chondral pathology. Surgeons worldwide have demonstrated the successful treatment of these lesions via arthroscopic and open techniques. The aim of this study is to validate a simple and reproducible classification system for acetabular chondral lesions. In our classification system, the acetabulum is first divided into 6 zones as described by Ilizalithurri VM et al [Arthroscopy 24(5) 534-539]. The cartilage is then graded as 0 to 4 as follows: Grade 0 – normal articular cartilage lesions; Grade 1 softening or wave sign; Grade 2 - cleavage lesion; Grade 3 - delamination and Grade 4 –exposed bone. The site of the lesion is further typed as A, B or C based on whether the lesion is 1/3 distance from acetabular rim to cotyloid fossa, 1/3 to 2/3 distance from acetabular rim to cotyloid fossa and > 2/3 distance from acetabular rim to cotyloid fossa. For validating the classification system, six surgeons reviewed 14 hip arthroscopy video clips. All surgeons were provided with written explanation of our classification system. Each surgeon then individually graded the cartilage lesion. A single observer then compared results for observer variability using kappa statistics.Introduction
Methods
